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Shivaji S, Jayasudha R, Prashanthi GS, Arunasri K, Das T. Fungi of the human eye: Culture to mycobiome. Exp Eye Res 2022; 217:108968. [PMID: 35120870 DOI: 10.1016/j.exer.2022.108968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/02/2021] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Abstract
The focus of the current review is multi-fold and compares the diversity and abundance of fungi on the ocular surface by the conventional culture-based method with the more sensitive, high throughput, culture-independent NGS method. The aim is to highlight the existence of a core ocular mycobiome and explore the transition of the ocular fungal microbiota from the normal eye to the diseased eye. PubMed, Google Scholar and Medline were used to search for publications and reviews related to cultivable fungi and the mycobiome of the normal and diseased eye. The conventional cultivable approach and the NGS approach confirm that the eye has its own mycobiome and several confounding factors (age, gender, ethnicity etc.) influence the mycobiome. Further, dysbiosis in the mycobiome appears to be associated with ocular diseases and thus impacts the health of the human eye. Considering that the mycobiome of the eye is influenced by several confounding factors and also varies with respect to the disease status of the eye there is a need to extensively explore the mycobiome under different physiological conditions, different ethnicities, geographical regions etc. Such studies would unravel the diversity and abundance of the mycobiomes and contribute to our understanding of ocular health. Research focused on ocular mycobiomes may eventually help to build a targeted and individualized treatment.
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Affiliation(s)
- Sisinthy Shivaji
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Rajagopalaboopathi Jayasudha
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Gumpili Sai Prashanthi
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Kotakonda Arunasri
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
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Greydanus DE, Cabral MD, Patel DR. Pelvic inflammatory disease in the adolescent and young adult: An update. Dis Mon 2021; 68:101287. [PMID: 34521505 DOI: 10.1016/j.disamonth.2021.101287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
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3
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Gupta P, Gupta N. Cervical cytology in the detection of polymicrobial cervicitis. Cytopathology 2021; 32:847-849. [PMID: 34033151 DOI: 10.1111/cyt.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
Patients with human immunodeficiency virus infection are at an increased risk of acquiring multiple sexually transmitted diseases. Establishing a cytological diagnosis of multiple viral infections on cervical cytology may be challenging due to its relative rarity as well as a lack of familiarity with the characteristic cytological features. Herein, we describe the cytological features of dual human papillomavirus and herpes simplex virus on a liquid-based cytology cervical preparation.
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Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Nava-Memije K, Hernández-Cortez C, Ruiz-González V, Saldaña-Juárez CA, Medina-Islas Y, Dueñas-Domínguez RA, Aguilera-Arreola MG. Bacterial Vaginosis and Sexually Transmitted Infections in an HIV-Positive Cohort. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:660672. [DOI: 10.3389/frph.2021.660672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
The World Health Organization (WHO) and the Joint United Nations Programme on HIV and AIDS (UNAIDS) suggest that sexually transmitted infection (STI) surveillance should include other genital infections and not only human immunodeficiency virus (HIV). To monitor the concomitance of bacterial vaginosis (BV) and STIs in HIV-seropositive (HIV+) and HIV-seronegative (HIV–) patients, a prospective study was conducted in a cohort of 349 volunteers at a clinic specializing in treating STIs in Mexico City. Microbiological and molecular methods were used to detect STIs and dysbiosis in HIV+ and HIV– individuals. The prevalence of infection was higher in HIV+ (69.28%) than in HIV– (54.87%) individuals. BV was the most frequent infection in HIV+ individuals, and polymicrobial infections were 3 times more common in HIV+ individuals than in HIV– individuals (31.48 vs. 10.98%). Behaviors documented in a self-administered questionnaire included low condom use frequency in HIV+ individuals co-infected with BV or a STI. This finding highlights the importance of surveillance using routine microbiological evaluations for the correct management of genital infections in HIV+ patients because in the presence of HIV, the clinical presentations, courses, and therapeutic responses of some STIs can differ from those in patients without HIV infection.
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Farsimadan M, Motamedifar M. The effects of human immunodeficiency virus, human papillomavirus, herpes simplex virus-1 and -2, human herpesvirus-6 and -8, cytomegalovirus, and hepatitis B and C virus on female fertility and pregnancy. Br J Biomed Sci 2020; 78:1-11. [PMID: 32726192 DOI: 10.1080/09674845.2020.1803540] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Female infertility may be defined as a woman of reproductive age being unable to become pregnant after a year of regular unprotected sexual intercourse. Social, genetic, endocrine, physiological, and psychological factors as well as lifestyle habits (i.e., smoking and alcohol consumption), either alone or in combination with male factors, are major causes. However, approximately 15-30% of cases of female infertility remain unexplained. Numerous investigations have also indicated that microbiomes play an important role in human reproduction. All parts of the female reproductive system may be influenced by infectious and pathological agents, especially viruses, and these may interfere with reproductive function and so are risk factors for infertility, although in many cases an exact role is unclear. We present an overview of the impact of common viral infections on female reproduction, searching Medline, PubMed, Scopus, and Google scholar databases for potentially relevant studies of viruses known to have a potential effect. Human immunodeficiency virus (HIV), herpes simplex virus (HSV) and human herpesvirus (HHV) increase infertility rates whilst human papillomavirus (HPV), cytomegalovirus (CMV), and hepatitis B and C virus (HBV, HCV) infections mostly lead to higher abortion and miscarriage rates. Moreover, HPV infection is linked to increased tubal infertility, endometriosis, and pelvic inflammatory disease. HPV was the most frequently observed infection and with lower pregnancy rate and foetal death in women undergoing IVF treatments. Assisted reproductive treatment could be a safe and effective approach for HIV and HBV infected women.
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Affiliation(s)
- M Farsimadan
- Department of Biology, Faculty of Sciences, University of Guilan , Rasht, Iran
| | - M Motamedifar
- Department of Bacteriology and Virology, Shiraz Medical School, and Shiraz HIV/Aids Research Center, Institute of Health, Shiraz University of Medical Sciences , Shiraz, Iran
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Teh J, Pasvol T, Ayres S, Foster C, Fidler S. Case series of infertility amongst young women with perinatally acquired HIV: data from a London cohort. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30278-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Reda S, Gonçalves FA, Mazepa MM, De Carvalho NS. Women infected with HIV and the impact of associated sexually transmitted infections. Int J Gynaecol Obstet 2018; 142:143-147. [PMID: 29656416 DOI: 10.1002/ijgo.12507] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/27/2018] [Accepted: 04/06/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To review the relationship between concomitant sexually transmitted infections in women infected with HIV. METHODS PubMed and Scopus were searched for articles published in English and Portuguese between January 1, 1994, and December 31, 2015, using relevant keywords, including AIDS, HIV, female genital diseases, and sexually transmitted infections. Articles that associated sexually transmitted infections with HIV-infected women were selected for inclusion. Those that only investigated prevalence in pregnant women or focused on social or behavioral aspects were excluded. RESULTS Of 108 identified articles, 24 were included. When correlated with HIV, genital herpes demonstrated an increased recurrence rate and increased replication rate for HIV in the mucosa. In HIV-positive women, syphilis can cause more genital ulcers. Bacterial vaginosis provides a pool of microorganisms that can increase the viral copy levels of genital HIV. Chlamydia, gonorrhea, and candidiasis may be more severe and complicated in women infected with HIV. CONCLUSIONS Screening of HIV-positive patients who could have other sexually transmitted infections is important to protect women and decrease the risk of transmission.
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Affiliation(s)
- Somaia Reda
- Obstetrics and Gynecology Department, Sector of Infectious Diseases in Obstetrics and Gynecology, Clinical Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil.,University Positivo, Curitiba, Paraná, Brazil
| | - Fernanda Aguiar Gonçalves
- Obstetrics and Gynecology Department, Sector of Infectious Diseases in Obstetrics and Gynecology, Clinical Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Melissa Mello Mazepa
- Obstetrics and Gynecology Department, Sector of Infectious Diseases in Obstetrics and Gynecology, Clinical Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Newton Sérgio De Carvalho
- Obstetrics and Gynecology Department, Sector of Infectious Diseases in Obstetrics and Gynecology, Clinical Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil.,Post Graduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Paraná, Brazil
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Huseyin CE, O'Toole PW, Cotter PD, Scanlan PD. Forgotten fungi-the gut mycobiome in human health and disease. FEMS Microbiol Rev 2017; 41:479-511. [PMID: 28430946 DOI: 10.1093/femsre/fuw047] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 01/04/2017] [Indexed: 12/11/2022] Open
Abstract
The human body is home to a complex and diverse microbial ecosystem that plays a central role in host health. This includes a diversity of fungal species that is collectively referred to as our 'mycobiome'. Although research into the mycobiome is still in its infancy, its potential role in human disease is increasingly recognised. Here we review the existing literature available on the human mycobiota with an emphasis on the gut mycobiome, including how fungi interact with the human host and other microbes. In doing so, we provide a comprehensive critique of the methodologies available to research the human mycobiota as well as highlighting the latest research findings from mycological surveys of different groups of interest including infants, obese and inflammatory bowel disease cohorts. This in turn provides new insights and directions for future studies in this burgeoning research area.
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Affiliation(s)
- Chloe E Huseyin
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork P61 C996, Ireland.,APC Microbiome Institute, Biosciences Institute, University College Cork, Cork T12 YT20 Ireland.,School of Microbiology, University College Cork, Cork T12 YT20, Ireland
| | - Paul W O'Toole
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork T12 YT20 Ireland.,School of Microbiology, University College Cork, Cork T12 YT20, Ireland
| | - Paul D Cotter
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork P61 C996, Ireland.,APC Microbiome Institute, Biosciences Institute, University College Cork, Cork T12 YT20 Ireland
| | - Pauline D Scanlan
- APC Microbiome Institute, Biosciences Institute, University College Cork, Cork T12 YT20 Ireland
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Role of microbial flora in female genital tract: A comprehensive review. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(16)61155-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
OBJECTIVE To evaluate HIV directly or indirectly related altered ovarian function, using serum anti-Müllerian hormone (AMH) levels in HIV-infected women as compared with seronegative women. DESIGN We conducted a matched cohort study from January 2008 to December 2013 in a tertiary university centre. Two hundred and one HIV-infected women requesting assisted reproductive technology and 603 age and cause of infertility-matched HIV seronegative women were enrolled in this study. METHODS All data were prospectively collected using a semistructured questionnaire. Serum AMH levels in HIV-infected women and matched controls were compared. To find out the contributing factors to increased serum AMH levels in HIV-infected women, a backward multiple linear regression was performed. RESULTS Serum AMH levels were significantly lower in HIV-infected group as compared with seronegative controls (3.0 ± 2.8 vs 3.7 ± 3.5 ng/ml; respectively, P = 0.001). Looking for factors associated with altered AMH among HIV-infected women, an association has been shown between tubal disease and a further decrease in serum AMH levels (2.4 ± 2.4 vs 3.4 ± 3.0 ng/ml; respectively, P = 0.011). Among HIV-infected women, after multivariate linear regression analysis, we showed that increased age, BMI and viral load were associated with decreased serum AMH levels whereas in striking contrast an increase in CD4⁺ cell count was associated with an increase of serum AMH levels. CONCLUSION Serum AMH levels were lower in the HIV-infected group than in the control group. Age, BMI, CD4⁺ cell count and viral load were the independent contributors affecting serum AMH levels among HIV-infected women.
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Lights and Shadows about the Effectiveness of IVF in HIV Infected Women: A Systematic Review. Infect Dis Obstet Gynecol 2015; 2015:517208. [PMID: 26778910 PMCID: PMC4686718 DOI: 10.1155/2015/517208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/06/2015] [Accepted: 11/12/2015] [Indexed: 01/20/2023] Open
Abstract
Background. HIV infected women have higher rates of infertility. Objective. The purpose of this literature review is to evaluate the effectiveness of fresh IVF/ICSI cycles in HIV infected women. Materials and Methods. A search of the PubMed database was performed to identify studies assessing fresh nondonor oocyte IVF/ICSI cycle outcomes of serodiscordant couples with an HIV infected female partner. Results and Discussion. Ten studies met the inclusion criteria. Whenever a comparison with a control group was available, with the exception of one case, ovarian stimulation cancelation rate was higher and pregnancy rate (PR) was lower in HIV infected women. However, statistically significant differences in both rates were only seen in one and two studies, respectively. A number of noncontrolled sources of bias for IVF outcome were identified. This fact, added to the small size of samples studied and heterogeneity in study design and methodology, still hampers the performance of a meta-analysis on the issue. Conclusion. Prospective matched case-control studies are necessary for the understanding of the specific effects of HIV infection on ovarian response and ART outcome.
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Zi MYH, Longo PL, Bueno-Silva B, Mayer MPA. Mechanisms Involved in the Association between Periodontitis and Complications in Pregnancy. Front Public Health 2015; 2:290. [PMID: 25688342 PMCID: PMC4310218 DOI: 10.3389/fpubh.2014.00290] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 12/14/2014] [Indexed: 01/08/2023] Open
Abstract
The association between periodontitis and some of the problems with pregnancy such as premature delivery, low weight at birth, and preeclampsia (PE) has been suggested. Nevertheless, epidemiological data have shown contradictory data, mainly due to differences in clinical parameters of periodontitis assessment. Furthermore, differences in microbial composition and immune response between aggressive and chronic periodontitis are not addressed by these epidemiological studies. We aimed to review the current data on the association between some of these problems with pregnancy and periodontitis, and the mechanisms underlying this association. Shifts in the microbial composition of the subgingival biofilm may occur during pregnancy, leading to a potentially more hazardous microbial community. Pregnancy is characterized by physiological immune tolerance. However, the infection leads to a shift in maternal immune response to a pathogenic pro-inflammatory response, with production of inflammatory cytokines and toxic products. In women with periodontitis, the infected periodontal tissues may act as reservoirs of bacteria and their products that can disseminate to the fetus-placenta unit. In severe periodontitis patients, the infection agents and their products are able to activate inflammatory signaling pathways locally and in extra-oral sites, including the placenta-fetal unit, which may not only induce preterm labor but also lead to PE and restrict intrauterine growth. Despite these evidences, the effectiveness of periodontal treatment in preventing gestational complications was still not established since it may be influenced by several factors such as severity of disease, composition of microbial community, treatment strategy, and period of treatment throughout pregnancy. This lack of scientific evidence does not exclude the need to control infection and inflammation in periodontitis patients during pregnancy, and treatment protocols should be validated.
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Affiliation(s)
- Marcela Yang Hui Zi
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Priscila Larcher Longo
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Bruno Bueno-Silva
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Marcia Pinto Alves Mayer
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Barnes A, Riche D, Mena L, Sison T, Barry L, Reddy R, Shwayder J, Parry JP. Efficacy and safety of intrauterine insemination and assisted reproductive technology in populations serodiscordant for human immunodeficiency virus: a systematic review and meta-analysis. Fertil Steril 2014; 102:424-34. [DOI: 10.1016/j.fertnstert.2014.05.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/27/2014] [Accepted: 05/01/2014] [Indexed: 02/05/2023]
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Nurudeen SK, Grossman LC, Bourne L, Guarnaccia MM, Sauer MV, Douglas NC. Reproductive Outcomes of HIV Seropositive Women Treated by Assisted Reproduction. J Womens Health (Larchmt) 2013; 22:243-9. [DOI: 10.1089/jwh.2012.3855] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sahadat K. Nurudeen
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Lisa C. Grossman
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Lawton Bourne
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Michael M. Guarnaccia
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Mark V. Sauer
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nataki C. Douglas
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, College of Physicians and Surgeons, Columbia University, New York, New York
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Savasi V, Mandia L, Laoreti A, Cetin I. Reproductive assistance in HIV serodiscordant couples. Hum Reprod Update 2012; 19:136-50. [PMID: 23146867 DOI: 10.1093/humupd/dms046] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Three quarters of individuals infected with human immunodeficiency virus (HIV) are in their reproductive years and may consider pregnancy planning. Techniques have been developed which can minimize the risk of HIV transmission in these couples, and the current literature on this topic is reviewed here. METHODS We reviewed the literature for the following topics: risk of HIV transmission, effects of HIV infection on fertility, reproductive assistance in industrialized and low-income countries, pre-exposure chemoprophylaxis (PrEP) and timed intercourse in HIV-discordant couples for both male and female positivity. Relevant publications were identified through searches of the EMBASE Medline and PubMed databases, the Google-indexed scientific literature and periodic specialized magazines from the on-line Library Service of the University of Milan, Italy. RESULTS In serodiscordant couples in which the man is positive, the primary method used to prevent HIV transmission is 'sperm washing', followed by IUI or IVF. Data show that sperm washing in HIV-positive men has not produced seroconversion in women or their offspring; however, the evidence is limited. Recently, increasing evidence describing PrEP for HIV prevention has been published and PrEP could be an alternative to ART for fertile couples. Usually HIV-infected women undergo self-insemination around the time of ovulation. Few studies have been published on IVF outcome in HIV-infected women. CONCLUSIONS Assisted reproduction programmes should be integrated into global public health services against HIV. For HIV serodiscordant couples with infected men, sperm washing should be the first choice. However, timed intercourse and PrEP for HIV prevention has been reported. Recent data highlight the possible impairment of fertility in HIV-infected women. Efforts to design a multicentric study should be strengthened.
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Affiliation(s)
- V Savasi
- Unit of Obstetrics and Gynecology, Department of Clinical Sciences, Hospital L. Sacco, University of Milan, Via G. B. Grassi, 74, 20157 Milan, Italy.
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Abstract
PURPOSE OF REVIEW It is becoming increasingly important to address the issue of reproductive counselling and management of HIV-infected individuals during their reproductive years. Sexual and reproductive health-related needs and aspirations are similar to those of uninfected individuals but some differences require specific attention, which are discussed in this review. RECENT FINDINGS Hormonal contraception should be used with caution in women on antiretroviral treatment. Its impact on both HIV infectivity and disease progression is still controversial. An intrauterine device can be considered for pregnancy prevention and pregnancy termination should be offered in safe conditions. HIV-infected women have a lower spontaneous fertility rate, which may persist after assisted reproduction. Data on safety of antiretroviral treatment during conception are reassuring. No clear association can be found between exposure to antiretrovirals and fetal abnormalities. Secondary prevention remains crucial and condom use remains a key method. SUMMARY Different topics related to fertility choices among HIV-infected patients should be addressed. Family planning methods and termination of pregnancy have specific aspects among infected individuals. When needed, medically assisted reproduction may be required and antiretroviral treatment should be adapted before conception. Secondary prevention has a key role in reducing newly acquired infections.
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Zhang Y, Margolese S, Yudin MH, Raboud JM, Diong C, Hart TA, Shapiro HM, Librach C, Gysler M, Loutfy MR. Desires, Need, Perceptions, and Knowledge of Assisted Reproductive Technologies of HIV-Positive Women of Reproductive Age in Ontario, Canada. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:853503. [PMID: 22957265 PMCID: PMC3431126 DOI: 10.5402/2012/853503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 06/03/2012] [Indexed: 11/23/2022]
Abstract
The purpose of this cross-sectional study is to assess the desire, need, perceptions, and knowledge of assisted reproductive technologies (ARTs) for women living with HIV (WLWHIV) and determine correlates of ART knowledge desire. WLWHIV of reproductive age were surveyed using the survey instrument "The HIV Pregnancy Planning Questionnaire" at HIV/AIDS service organizations across Ontario, Canada. Of our cohort of 500 WLWHIV, median age was 38, 88% were previously pregnant, 78% desired more information regarding ART, 59% were open to the idea of receiving ART, 39% felt they could access a sperm bank, and 17% had difficulties conceiving (self-reported). Age, African ethnicity, and residence in an urban center were correlated with desire for more ART information. Of participants, 50% wanted to speak to an obstetrician/gynecologist regarding pregnancy planning, and 74% regarded physicians as a main source of fertility service information. While the majority of participants in our cohort desire access to ART information, most do not perceive these services as readily accessible. Healthcare practitioners were viewed as main sources of information regarding fertility services and need to provide accurate information regarding access. Fertility service professionals need to be aware of the increasing demand for ART among WLWHIV.
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Affiliation(s)
- Yimeng Zhang
- Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada M5G 1N6
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 3K1
| | - Shari Margolese
- Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada M5G 1N6
| | - Mark H. Yudin
- Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada M5B 1W8
| | - Janet M. Raboud
- Clinical Decision Making and Health Care, University Health Network, Toronto, ON, Canada M5G 2C4
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada M5S 1A1
| | - Christina Diong
- Clinical Decision Making and Health Care, University Health Network, Toronto, ON, Canada M5G 2C4
| | - Trevor A. Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada M5S 1A1
- Department of Psychology, Ryerson University, Toronto, ON, Canada M5B 2K3
| | - Heather M. Shapiro
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada M5G 1X5
| | - Cliff Librach
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada M4N 3M5
| | - Matt Gysler
- Department of Obstetrics and Gynecology, Credit Valley Hospital, Mississauga, ON, Canada L5M 2N1
| | - Mona R. Loutfy
- Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada M5G 1N6
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 3K1
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18
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Santulli P, Gayet V, Fauque P, Chopin N, Dulioust E, Wolf JP, Chapron C, de Ziegler D. HIV-positive patients undertaking ART have longer infertility histories than age-matched control subjects. Fertil Steril 2011; 95:507-12. [DOI: 10.1016/j.fertnstert.2010.09.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 08/29/2010] [Accepted: 09/14/2010] [Indexed: 11/17/2022]
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Intractable Chronic Vulval Ulceration Presenting as Immune Reconstitution Inflammatory Syndrome in a Treatment-Failure Patient: A Case Observation. Case Rep Obstet Gynecol 2011; 2011:896964. [PMID: 22567519 PMCID: PMC3335519 DOI: 10.1155/2011/896964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 07/13/2011] [Indexed: 11/21/2022] Open
Abstract
HIV-1 treatment-failure patients are increasingly being initiated on second-line antiretroviral therapy. The case we describe is of a treatment-failure patient who developed intractable chronic vulval ulceration presenting as immune reconstitution inflammatory syndrome (IRIS), following complete viral suppression with second-line highly active antiretroviral treatment (HAART). To the best of our knowledge, this is the first reported case of intractable vulval ulceration IRIS in an HIV-1 treatment-failure patient.
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20
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CD57 expression by T cells in the female genital tract of HIV-zx1 infected women. Clin Immunol 2010; 135:137-45. [PMID: 20100671 PMCID: PMC2843828 DOI: 10.1016/j.clim.2009.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 12/14/2009] [Accepted: 12/19/2009] [Indexed: 11/23/2022]
Abstract
Despite an influx of T cells to the cervix during HIV infection, genital T cells are not associated with control of HIV shedding. CD57 expression by T cells has been associated with enhanced migratory potential and CD57+ T cells have been shown to accumulate in tissues during the late stages of HIV disease. We investigated the impact of HIV-infection and clinical status on the expression of CD57 by T cells from the female genital tract in 13 HIV-infected and 5 uninfected women. We found that cervical and blood-derived T cells expressed similar frequencies of CD57. The frequency of CD57 expression by cervical or blood T cells was not associated with clinical status (CD4 counts). No impairment in IFN-γ production by CD57+ T cells from the genital tract was observed. We conclude that increased T cell senescence does not appear to be a hallmark of genital mucosal HIV-1 infection.
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Nkwanyana NN, Gumbi PP, Roberts L, Denny L, Hanekom W, Soares A, Allan B, Williamson AL, Coetzee D, Olivier AJ, Burgers WA, Passmore JA. Impact of human immunodeficiency virus 1 infection and inflammation on the composition and yield of cervical mononuclear cells in the female genital tract. Immunology 2009; 128:e746-57. [PMID: 19740336 DOI: 10.1111/j.1365-2567.2009.03077.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cervical cytobrush sampling is a relatively non-invasive method for obtaining mucosal cells from the female genital tract. To define mucosal immune cells sampled by cervical cytobrushing and to validate this approach for local immunity studies, we investigated the impact of human immunodeficiency virus (HIV) status and inflammation on the yield and composition of cervical cytobrush specimens. Cervical cytobrush samples were obtained from 89 chronically HIV-infected and 46 HIV-negative women. The HIV-infected women had significantly higher yields of CD3(+), CD45(+), CD19(+), CD14(+), Langerin(+) and CD24(+) cells than the uninfected women. While cytobrush-derived T cells from uninfected women were predominantly CD4(+) (4.2 CD4 : 1 CD8), CD8(+) T cells were predominant in HIV-infected women (0.6 CD4 : 1 CD8). The majority of CD4(+) and CD8(+) T cells from HIV-infected and uninfected women were of the effector memory (CD45RA(-) CCR7(-) CD27(-)) phenotype. HIV-infected women had significantly elevated levels of interleukin (IL)-1beta, IL-6 and IL-8 in cervical supernatants compared with uninfected women. We observed a significant positive correlation between T-cell counts and IL-1beta, tumour necrosis factor (TNF)-alpha and IL-12 concentrations. Neutrophil counts correlated significantly with cervical concentrations of IL-1beta, TNF-alpha, IL-8, IL-6 and IL-10. Antigen-presenting cell numbers correlated significantly with TNF-alpha and IL-12 concentrations. HIV-infected women on antiretroviral therapy had similar levels of cervical lymphocyte infiltration and inflammation to women naïve to therapy. In conclusion, we suggest that inflammation at the cervix and HIV infection are likely to be key determinants in the absolute number of mucosal immune cells recovered by cervical cytobrushing.
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Affiliation(s)
- Nonhlanhla N Nkwanyana
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Semprini AE, Hollander LH, Vucetich A, Gilling-Smith C. Infertility Treatment for HIV-Positive Women. WOMENS HEALTH 2008; 4:369-82. [DOI: 10.2217/17455057.4.4.369] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Thanks to antiretroviral combination therapy, HIV-infected individuals live longer, healthier lives and may wish to have children. Women with HIV can attempt to conceive naturally or through simple self-insemination to minimize the risk of horizontal HIV transmission. Assisted reproduction technology is necessary in couples with infertility, which can either be independent of HIV infection and its treatment or be associated with it. This article summarizes the latest evidence regarding the desire for a child in HIV-positive women and how HIV infection and its treatment may impact female fertility. Current data regarding access to and outcomes of assisted conception programs in HIV-positive women wishing to conceive in both high- and low-income countries is also reviewed.
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Affiliation(s)
- Augusto Enrico Semprini
- ESMAN Medical Consulting, Via Carlo Crivelli, 20 20122 Milano, Italy, Tel.: +39 025 843 0703; Fax: +39 025 830 4466
| | - Lital Hannah Hollander
- ESMAN Medical Consulting, Via Carlo Crivelli, 20 20122 Milano, Italy, Tel.: +39 025 843 0703; Fax: +39 025 830 4466
- Tel.: +39 024 549 1134; Fax: +39 024 549 1135
| | - Alessandra Vucetich
- ESMAN Medical Consulting, Via Carlo Crivelli, 20 20122 Milano, Italy, Tel.: +39 025 843 0703; Fax: +39 025 830 4466
- Tel.: +39 025 843 0703; Fax: +39 02 5830 4466
| | - Carole Gilling-Smith
- Chelsea & Westminster Hospital, Assisted Conception Unit, London SW10 9NH, UK, Tel.: +44 172 8746 8000; Fax: +44 172 8746 8921
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23
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Spear GT, Zariffard MR, Cohen MH, Sha BE. Vaginal IL-8 levels are positively associated with Candida albicans and inversely with lactobacilli in HIV-infected women. J Reprod Immunol 2008; 78:76-9. [PMID: 18243333 DOI: 10.1016/j.jri.2007.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 10/31/2007] [Accepted: 11/05/2007] [Indexed: 10/22/2022]
Abstract
IL-8/CXCL8 is induced during infections, but has not been reported for Candida albicans colonization of the female genital tract. Cervicovaginal lavage (CVL) samples were collected from 406 HIV-infected women. IL-8 levels were evaluated by ELISA and compared with levels of C. albicans detected by potassium hydroxide (KOH) and PCR. Levels of lactobacilli, Gardnerella vaginalis and Mycoplasma hominis were also determined by PCR. IL-8 was significantly higher in samples from women with Candida, and regression analysis showed a positive association between IL-8 and Candida. In contrast, there was an inverse relationship between lactobacilli and IL-8. G. vaginalis and M. hominis were not significantly associated with IL-8. This study has shown an association between C. albicans and levels of IL-8 in mucosal genital fluid.
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Affiliation(s)
- Gregory T Spear
- Department of Immunology/Microbiology, Rush University Medical Center, Chicago, IL 60612, USA.
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24
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Spear GT, St John E, Zariffard MR. Bacterial vaginosis and human immunodeficiency virus infection. AIDS Res Ther 2007; 4:25. [PMID: 17953761 PMCID: PMC2164939 DOI: 10.1186/1742-6405-4-25] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 10/22/2007] [Indexed: 01/08/2023] Open
Abstract
Epidemiologic studies indicate that bacterial vaginosis (BV), a common alteration of lower genital tract flora in women, is associated with increased susceptibility to HIV infection. Other recent studies show that HIV is detected more frequently and at higher levels in the lower genital tract of HIV-seropositive women with BV. In vitro studies show that genital tract secretions from women with BV or flora associated with BV induce HIV expression in infected cells. The increased HIV expression appears to be due at least in part to activation through Toll-like receptors (TLR), specifically TLR2. Further research is needed to elucidate how BV contributes to HIV acquisition and transmission.
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Abstract
Many HIV-infected women are benefiting from highly active antiretroviral therapy and living longer. Their reproductive choices vary over the life cycle, and there is a need to understand the appropriate contraceptives for those not intending pregnancy. There are specific gynecologic issues relevant to HIV-infected women, such as genital tract infections, risk for cervical cancer, and menstrual irregularities. More women are expected to reach menopause. Health care providers should be aware of these unique needs of HIV-infected women.
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Affiliation(s)
- Erna Milunka Kojic
- Division of Infectious Diseases, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02806, USA.
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26
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Coll O, Lopez M, Vidal R, Figueras F, Suy A, Hernandez S, Loncà M, Palacio M, Martinez E, Vernaeve V. Fertility assessment in non-infertile HIV-infected women and their partners. Reprod Biomed Online 2007; 14:488-94. [PMID: 17425832 DOI: 10.1016/s1472-6483(10)60897-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of the study was to assess the fertility of non-infertile couples seeking pregnancy in whom the woman was HIV infected. Therefore, a cross-sectional study was conducted between January 1998 and March 2005. A standardized fertility assessment was performed in all the included couples. A total of 130 women and 121 men were evaluated. Their median age was 34 years (range 22-43). Only 7.2% of the women were severely immunocompromised. The majority of women had regular cycles. Only one woman had an active sexually transmitted disease at the time of evaluation. A tubal occlusion on hysterosalpingogram was present in 27.8% of the women with no proven fertility. In 50.5% of the women, hepatitis C virus co-infection was present. One-third of the male partners (38/121) was infected with HIV. Abnormal semen parameters were observed in 83.4% of HIV-infected and 41.7% of HIV-uninfected partners (OR = 7; 95% CI = 2.1-23). It is concluded that the great majority of the HIV-infected women seeking pregnancy had a good infection status. Because in many of the couples, the women presented unexplained tubal occlusions and the men presented semen alterations, a hysterosalpingography and semen analysis should be part of the preconceptional investigations.
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Affiliation(s)
- O Coll
- Department of Obstetrics, IDIBAPS, Hospital Clínic, University of Barcelona, Sabino de Arana, 1, 08028 Barcelona, Spain.
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27
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van Leeuwen E, Prins JM, Jurriaans S, Boer K, Reiss P, Repping S, van der Veen F. Reproduction and fertility in human immunodeficiency virus type-1 infection. Hum Reprod Update 2006; 13:197-206. [PMID: 17099206 DOI: 10.1093/humupd/dml052] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Human immunodeficiency virus type-1 (HIV-1) affects mostly men and women in their reproductive years. For those who have access to highly active antiretroviral therapy (HAART), the course of HIV-1 infection has shifted from a lethal to a chronic disease. As a result of this, many patients with HIV-1 consider having offspring, as do other patients of reproductive age with chronic illnesses. This article summarizes the current knowledge on the presence of HIV in the male and female genital tract, the effects of HIV-1 infection and HAART on male and female fertility and the results of various assisted reproduction techniques (ART) in HIV-1-infected men and women who wish to have offspring.
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Affiliation(s)
- E van Leeuwen
- Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
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28
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Manigart Y, Rozenberg S, Barlow P, Gerard M, Bertrand E, Delvigne A. ART outcome in HIV-infected patients. Hum Reprod 2006; 21:2935-40. [PMID: 16887923 DOI: 10.1093/humrep/del277] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To assess assisted reproductive technique (ART) outcome in couples affected by human immunodeficiency virus (HIV). METHODS Intrauterine insemination (IUI), IVF and ICSI were performed in 85 couples affected by HIV between January 2000 and June 2005. RESULTS In 33 of the 85 couples, women were HIV positive-the clinical pregnancy rate (CPR) and cancellation rate (CR) after 34 IUI cycles were, respectively, 25 and 18%. The CPR after 26 IVF and 30 ICSI cycles were, respectively, 37.5 and 18.8% with CRs of 38.5 and 46.7%, respectively. In 38 couples, men were infected-the CPR and CR after 85 IUI cycles were, respectively, 14.7 and 20%; 62 ICSI cycles were performed leading to CPR of 23.4% with a CR of 25%. In 14 couples, the two partners were infected: none of the four IUI cycles carried out was successful (CR, 20%); the CPR and CR after 35 ICSI cycles were, respectively, 12.5% with 31%. All children born had a negative HIV test. CONCLUSION In couples affected by HIV, an acceptable pregnancy rate was obtained. The worst results were obtained when both partners were infected. The CR was elevated among HIV-infected couples.
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Affiliation(s)
- Y Manigart
- Department of Obstetrics and Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, Brussels, Belgium
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29
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Gorbach PM, Sopheab H, Chhorvann C, Weiss RE, Vun MC. Changing Behaviors and Patterns Among Cambodian Sex Workers. J Acquir Immune Defic Syndr 2006; 42:242-7. [PMID: 16639348 DOI: 10.1097/01.qai.0000214817.03411.80] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Identify patterns and behaviors among direct and indirect female sex workers (DFSWs and IDFSWs, respectively) across Cambodia's 5 major cities from 1997 to 2003. METHODS Interviews with DFSWs and IDFSWs followed random selection from clusters in 5 cities. Individual characteristics and condom use with clients and other partners were assessed in univariate and multivariate analyses. RESULTS From 1997 to 2003, consistent condom use with clients increased from 53% to 96% among DFSWs and from 30% to 84% among IDFSWs. DFSWs reported staying in their profession longer, had fewer clients per day, stayed longer in each brothel, were in increasingly larger brothels, and were tested more for HIV. For IDFSWs, there were significant changes: more reported practicing commercial sex and testing for HIV. In adjusted models, reported condom use with clients was significantly higher among DFSWs in later survey years (odds ratio [OR], 2.17) and who were never married (OR, 1.69), were in larger brothels (OR, 1.02), and charged more for sex (OR, 1.27), but lower for DFSWs with sweethearts (OR, 0.68) and who reported abnormal vaginal discharge (OR, 0.52). For IDFSWs, in the adjusted models, reported condom use with clients was higher in later years (OR, 1.77) and for those reporting abnormal vaginal discharge (OR, 1.34) and HIV testing (OR, 1.46), and lower for those with sweethearts (OR, 0.49). CONCLUSIONS From 1997 to 2003, Cambodian direct and indirect sex workers increased their use of condoms each year with commercial as well as noncommercial partners, contributing to the evidence that HIV prevention programs can produce significant changes in risk behaviors.
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Affiliation(s)
- Pamina M Gorbach
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA 900095, USA.
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30
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Myer L, Denny L, de Souza M, Wright TC, Kuhn L. Distinguishing the temporal association between women's intravaginal practices and risk of human immunodeficiency virus infection: a prospective study of South African women. Am J Epidemiol 2006; 163:552-60. [PMID: 16443804 DOI: 10.1093/aje/kwj071] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cross-sectional studies have suggested that intravaginal practices, such as douching or "dry sex," may increase women's susceptibility to infection with human immunodeficiency virus (HIV). The authors examined the temporal nature of this association in a cohort of South African women. At enrollment (2001-2002), 4,089 women were tested for HIV infection. Participants reported their intravaginal practices at a 6-month follow-up visit and were followed with repeat HIV testing for up to 24 months. Among the 3,570 women who were HIV-negative at enrollment, 26% reported some type of intravaginal practice, mostly washing inside the vagina with water and/or cloth as part of daily hygiene. During follow-up, 85 incident HIV infections were observed. Intravaginal practices were associated with prevalent HIV at enrollment (adjusted odds ratio = 1.50, 95% confidence interval: 1.22, 1.85), but during follow-up there was no association between intravaginal practices and incident HIV (adjusted hazard ratio = 1.04, 95% confidence interval: 0.65, 1.68). These findings may be explained by a reversal of the causal sequence assumed for this association, since intravaginal practices may be undertaken in response to vaginal infections that occur more commonly among HIV-infected women. Intravaginal practices appear unlikely to be a cofactor in the male-to-female transmission of HIV in this setting.
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Affiliation(s)
- Landon Myer
- Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa.
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Coll O, Suy A, Figueras F, Vernaeve V, Martínez E, Mataró D, Durban M, Lonca M, Vidal R, Gatell JM. Decreased pregnancy rate after in-vitro fertilization in HIV-infected women receiving HAART. AIDS 2006; 20:121-3. [PMID: 16327329 DOI: 10.1097/01.aids.0000196161.25647.35] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A study on in-vitro fertilization (IVF) was conducted among HIV-infected women. In these patients, a reduced pregnancy rate after IVF was observed if the patient's own oocytes were used. However, no significant reduction in the pregnancy rate was found if donated oocytes were used. The CD4 lymphocyte count was independently associated with ovarian resistance to hyperstimulation. Subclinical hypogonadism mediated by immunosuppression may explain these observations, suggesting the need to optimize the immunological status of the patient before considering assisted reproduction treatments.
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Affiliation(s)
- Oriol Coll
- Clinica Eugin, IDIBAPS, University of Barcelona, Barcelona, Spain
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32
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Myer L, Kuhn L, Stein ZA, Wright TC, Denny L. Intravaginal practices, bacterial vaginosis, and women's susceptibility to HIV infection: epidemiological evidence and biological mechanisms. THE LANCET. INFECTIOUS DISEASES 2005; 5:786-94. [PMID: 16310150 DOI: 10.1016/s1473-3099(05)70298-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intravaginal practices such as "dry sex" and douching have been suggested as a risk factor that may increase women's susceptibility to HIV infection. These behaviours appear common in different populations across sub-Saharan Africa, where practices include the use of antiseptic preparations, traditional medicines, or the insertion of fingers or cloths into the vagina. We systematically review the evidence for the association between women's intravaginal practices and HIV infection. Although a number of cross-sectional studies have shown that prevalent HIV infection is more common among women reporting intravaginal practices, the temporal nature of this association is unclear. Current evidence suggests that bacterial vaginosis, which is a likely risk factor for HIV infection, may be a mediator of the association between intravaginal practices and HIV. Although biologically plausible mechanisms exist, there is currently little epidemiological evidence suggesting that intravaginal practices increase women's susceptibility to HIV infection. Further research into factors that increase women's susceptibility to HIV will help to inform the design of vaginal microbicides and other HIV prevention interventions.
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Affiliation(s)
- Landon Myer
- Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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33
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Ohl J, Partisani M, Wittemer C, Lang JM, Viville S, Favre R. Encouraging results despite complexity of multidisciplinary care of HIV-infected women using assisted reproduction techniques. Hum Reprod 2005; 20:3136-40. [PMID: 16006462 DOI: 10.1093/humrep/dei185] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Assisted reproduction technologies can treat infertility for human immunodeficiency virus (HIV) seropositive women. We assessed the efficacy of these techniques in the results and difficulties encountered while conducting our assisted reproduction programme for 49 couples in which at least the woman had HIV infection that was currently under control. METHODS Treatments included intrauterine insemination (IUI), IVF and ICSI, with ovarian stimulation. Embryos were transferred on day 3 after oocyte retrieval. An elective single transfer was performed, except for patients aged > or = 40 years. RESULTS The median age of the women was 36 years. Ten IUI, nine IVF, 53 ICSI and 10 frozen-thawed embryo transfers have been performed. No pregnancy occurred following the IUI trials but for the couples with IVF and ICSI attempts the clinical pregnancy rate per embryo transfer was 23.9%. Eight babies have been born leading to a 22.2% take home baby rate per treated couple. Contamination was not observed in any newborn. CONCLUSIONS Assisted reproduction technologies and particularly ICSI can provide HIV seropositive women with a safe means of mothering children. Results are encouraging when considering the age of the patients and a preferential single embryo transfer.
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Affiliation(s)
- Jeanine Ohl
- Centre d'AMP de Strasbourg, Service de Gynécologie-Obstétrique, CMCO-SIHCUS, 19 rue Louis Pasteur--BP 120--67303 Schiltigheim.
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Abstract
Human immunodeficiency virus (HIV) infection primarily affects women during their reproductive years, and the co-existence of gynaecological infections is not surprising, given the fact that HIV is mainly acquired via heterosexual contact. Most gynaecological infections are themselves sexually acquired, and have the potential to increase the risk both of acquiring and transmitting the HI virus. As most sexually transmitted infections are asymptomatic, there is a need to improve methods of diagnosis and algorithms for early detection of sexually transmitted infections. HIV infection, however, particularly advanced disease, may alter the clinical presentation, course and response to conservative treatment for some of the sexually transmitted infections.
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Affiliation(s)
- Mothshedisi H Sebitloane
- Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella 4013, South Africa.
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Abstract
In countries where highly active antiretroviral therapy (HAART) is widely available, a decrease in the incidence of fungal infections has been observed in the last 5 years compared with countries that cannot afford this treatment. Even refractory fungal infections may be controlled when HAART is given to patients, and end-stage AIDS infections, such as aspergillosis, are now only infrequently seen. In contrast, fungal infections in certain regions, such as penicilliosis in Southeast Asia or cryptococcosis in Sub-Saharan Africa, are a growing problem. Antifungal therapy for documented infections has not changed very much during recent years; however, new drugs such as caspofungin and voriconazole may be more effective in the treatment of opportunistic fungal infections, in particular, those involving resistant organisms. Secondary antifungal prophylaxis for many opportunistic pathogens can now be temporarily or even permanently discontinued in many HIV-positive patients who have a marked improvement in immune function parameters, such as CD4(+) cell counts, after initiation of HAART. The link between effective virustatic control of HIV infection and a decreasing incidence of fungal infections has been recognised; and so, despite the availability of very effective new antifungal drugs, the cornerstone of treatment and prevention of opportunistic fungal infections in patients with HIV infection is effective antiretroviral therapy including protease inhibitors.
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Affiliation(s)
- Markus Ruhnke
- Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany.
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36
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Coombs RW, Reichelderfer PS, Landay AL. Recent observations on HIV type-1 infection in the genital tract of men and women. AIDS 2003; 17:455-80. [PMID: 12598766 DOI: 10.1097/00002030-200303070-00001] [Citation(s) in RCA: 181] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Robert W Coombs
- Departments of Laboratory Medicine and Medicine, University of Washington, Seattle, Washington, USA
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37
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Moodley P, Wilkinson D, Connolly C, Sturm AW. Influence of HIV-1 coinfection on effective management of abnormal vaginal discharge. Sex Transm Dis 2003; 30:1-5. [PMID: 12514433 DOI: 10.1097/00007435-200301000-00001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reports on microbiologic cure rates following syndromic management (SM) of women with nonulcerative sexually transmitted infections (STIs) are limited. GOAL The goal of the study was to determine the effectiveness of the drugs used in SM of nonulcerative STIs and bacterial vaginosis in women and to compare the response among those with and without HIV-1 coinfection. STUDY DESIGN This was a cohort study of women with nonulcerative STIs who were treated according to local SM protocols. RESULTS Of 692 women recruited, 415 (80%) returned 8 to 10 days later, and 290 (70%) consented to a second examination, in which specimens were obtained. Clinical cure was reported by 67%, and microbiologic cure ranged from 80% to 89% for the three discharge-causing STIs and was independent of HIV-1 status. Only 38% of those with bacterial vaginosis were cured, and HIV-1-infected women were less likely to be cured (28% versus 52%; P < 0.001). CONCLUSIONS Clinical and microbiologic response to SM of the nonulcerative STIs was not affected by HIV-1 coinfection, but cure rates for bacterial vaginosis were reduced.
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Affiliation(s)
- Prashini Moodley
- Africa Centre for Population Studies and Reproductive Health, Faculty of Medicine, University of Natal, Durban, South Africa
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38
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Abstract
Vaginitis is the most frequently gynecologic diagnosis encountered by physicians who provide primary care to women. Accurate diagnosis can be elusive, complicating treatment. Most experts believe that up to 90% of vaginitis cases are secondary to bacterial vaginosis, vulvo-vaginal candidiasis, and trichomoniasis. The diagnosis of vaginitis is based on the patient's symptoms, the physical examination, the findings of microscopic examination of the wetmount and potassium hydroxide (KOH) preparations, and the results of the pH litmus test. Additional cultures and testing may be needed for difficult-to-diagnose cases.
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Affiliation(s)
- Mari Egan
- Department of Family Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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39
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Moodley P, Wilkinson D, Connolly C, Moodley J, Sturm AW. Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Clin Infect Dis 2002; 34:519-22. [PMID: 11797180 DOI: 10.1086/338399] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2001] [Revised: 08/30/2001] [Indexed: 11/03/2022] Open
Abstract
We assessed the association between the causative agents of vaginal discharge and pelvic inflammatory disease (PID) among women attending a rural sexually transmitted disease clinic in South Africa; the role played by coinfection with human immunodeficiency virus type 1 (HIV-1) was studied. Vaginal and cervical specimens were obtained to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and bacterial vaginosis. HIV-1 infection was established by use of serum antibody tests. A total of 696 women with vaginal discharge were recruited, 119 of whom had clinical PID. Patients with trichomoniasis had a significantly higher risk of PID than did women without trichomoniasis (P=.03). PID was not associated with any of the other pathogens. When the patients were stratified according to HIV-1 status, the risk of PID in HIV-1-infected patients with T. vaginalis increased significantly (P=.002); no association was found in patients without HIV-1. T. vaginalis infection of the lower genital tract is associated with a clinical diagnosis of PID in HIV-1-infected women.
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Affiliation(s)
- Prashini Moodley
- Africa Centre for Population Studies and Reproductive Health and Departments of Medical Microbiology, Durban, South Africa
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